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People who are acutely ill out of hours should have easy access to a wider range of innovative medical services in the community to improve their care and reduce unnecessary hospital visits, a report by the Royal College of Physicians recommends.
The report, Acute Medical Care: The Right Person, in the Right Setting, First Time, argues that current out of hours care is generally inadequate and inflexible, so patients with acute illness go to hospitals because there is no alternative. It recommends that provision of acute, unscheduled medical care in the community should expand with a range of different levels of emergency care, offering extended opening times and direct access to competent staff.
New options might include urgent care centres in the community; rapid access medical outpatient clinics; and specialist outreach services from hospitals for acute deterioration of long term illness. These services must be evidence based, and the professionals delivering them must have the same competencies in acute medical care as hospital providers, it says.
Competent decision making requires diagnostic support, says the report, which calls for improved availability of these services. The task force that developed the recommendations, based on a review of available evidence, wants to replace “see and greet”—in which services provide an initial assessment before referring on—with “see and treat”—providing accurate assessment and delivery of treatment at the first contact.
Bryan Williams, professor of medicine at the University of Leicester, and chairman of the task force, said, “Getting it right for acute medical care needs changes in the way care is organised to get the most and the best out of staff and local resources and to provide fast and efficient care for patients. It needs changes in the way we work as professionals across the board, to provide wider and more flexible access to clinical decision makers.”
Big acute hospitals that serve local regions should provide the most intensive level of emergency and complex acute medical care in each area. They should have emergency departments located close to acute medical and critical care units, ideally as part of an emergency floor. Emergency care networks should be established to coordinate the planning and management of expanded acute care options in local regions, and research and development networks should be set up to improve the evidence base for best practice.
Quality assurance should be improved by standardising processes for assessment, documentation, and treatment of acute medical illness throughout the NHS. To achieve this, the task force recommends developing an NHS early warning score to standardise illness severity and urgency of need to trigger the most appropriate response, together with national clinical performance indicators, including mortality, cause specific outcomes, and patient satisfaction.
To ensure that people are aware of the range of services, the report recommends developing local navigation hubs, each with a single, well publicised access telephone number distinct from 999, the emergency services' number.
The report, Acute Medical Care: The Right Person, in the Right Setting, First Time, is available from the Royal College of Physicians, London NW1 4LE, priced £12.